Alberta doctors will no longer be able to quit en masse, should their regulatory college adopt new proposed policies.
In response to some doctors threatening to withdraw their services from rural hospitals, the College of Physicians and Surgeons of Alberta has proposed policy changes that would put new restrictions on physicians leaving an area or a practice.
If approved, one policy would require doctors to "stagger" their departures if they're involved in a dispute. Failure to follow the rules could potentially lead to doctors facing professional discipline — even losing their practice permits.
The proposals come after Alberta Health Minister Tyler Shandro told the college it must update the rules to better protect patients when doctors leave their posts.
Some of the changes are lifted nearly verbatim from the rules governing doctors in B.C.
Still, critics say the proposals raise questions about doctors' freedom of mobility, and spark fear a doctor would have to stay and work somewhere they don't want to.
"This whole thing could look like servitude if you're forced to keep working," said Dr. Paul Boucher, president of the Alberta Medical Association (AMA).
The college says the changes are about ensuring patients aren't left in the lurch.
That is an emerging risk as the Alberta government engages in a high-profile public relations war with doctors over the rising amount of public money spent on their compensation.
Anatomy of conflict
The doctors' college wants to amend three "standards of practice" — rules to which doctors must adhere to retain their professional status.
A dispute between doctors and the United Conservative government has continued for nearly a year, since the government gave itself the power in legislation to end its master agreement with physicians without cause. The government, which wants to curtail the increasing costs of paying doctors, introduced a set of proposed changes to how doctors are paid for some services.
Negotiations with the AMA went poorly. In February, Shandro tossed out the government's doctor agreement and said he would impose a new one.
Some doctors said the compensation changes made their businesses unviable, and threatened to cancel their privileges at rural hospitals. A few others are leaving Alberta, saying the political environment for doctors is unworkable.
Documents recently obtained by the Opposition NDP found that in the spring, Alberta Health Services was monitoring 160 doctors in 17 communities who were at "high risk" of withdrawing their services from hospitals.
An AMA survey found 42 per cent of respondents said they were considering leaving Alberta.
In the spring, the college started getting questions from doctors about withdrawing their services, registrar Dr. Scott McLeod said in an interview.
The college had begun drawing up more explicit policies when a June letter arrived from Shandro, demanding specific policy changes within a month.
McLeod said college leaders told the minister they had concerns about adopting rules that could potentially face constitutional challenges in court. They recommended following their usual process for changing policies, which include putting out drafts for consultation and feedback before a general council votes to adopt them.
The college is gathering feedback from doctors now. Its governing council will finalize the policies in December, and they should take effect in the new year.
Under the proposed changes, an "entire group of regulated members or an entire hospital department must not engage in a complete withdrawal of services" during a dispute.
While doctors retain their right to resign with notice, a group must "stagger such resignations" to allow reasonable time for their replacement or alternate care, the proposed standard says.
A group of doctors could only partially withdraw their services if it doesn't pose an "undue risk of harm" to patients, it says.
If the college finds doctors' contingency plans are inadequate, it may insist some of the doctors resume their duties, the proposed policy says.
To close or leave a practice, there are also proposed new requirements. They would have to give the college 90 days' notice, notify individual patients they are leaving, post general notices in their clinics, online and in newspapers, and arrange for transfer of care and records to other doctors.
McLeod said it would be "very rare" that a doctor holds patients' wellbeing hostage to make a political point. But if the college receives a complaint, investigators will look at the doctor's intent.
"If we truly felt that somebody was leveraging patients' health for their own personal interests, and there'd be a real potential harm to patients, then that would need to be considered unprofessional conduct and that would go through a formal hearing process," he said.
The potential limits on group resignations closely mirror existing policies in B.C. Although Ontario and Nova Scotia colleges also require doctors not to strand their patients without care, neither province forbids groups from halting work at once.
Could hit rural physicians hardest
AMA president Boucher said he agrees doctors shouldn't abandon their patients. However, he said proposed standards may tread too far into patient protection and infringe on doctors' freedom of mobility.
The policies could be particularly problematic in rural or remote areas, or in sub-specialties, where there are no nearby physicians trained to relieve them or take on patients, he said.
It would be a particularly unhealthy situation if a doctor stayed somewhere they were unhappy out of fear of professional sanctions, he said.
A burnt-out, disgruntled doctor isn't good for physicians or patients, and when doctors do warn of leaving, it's not a decision they take lightly, Boucher said.
"These are not flippant events that happen based on some whimsical decision of a practice group," he said. "No one wants to put their patient at a disadvantage."
Prof. Lorian Hardcastle, a health law expert at the University of Calgary, said the proposed changes would put Alberta's rules at the more restrictive end of the spectrum in Canada.
It's already difficult to attract some doctors to rural and remote practices, she said. With doctors feeling like they might be trapped, it becomes even more difficult.
"The government is really the one that was instrumental in creating some of these problems in the first place, and making recruitment and retention difficult," she said.
"I think it really is unethical to take that problem that they created and really make that (the) problem of these doctors to address on a one-off basis."
Steve Buick, press secretary to the health minister, pointed to similar requirements in other provinces and said the proposals would not make Alberta an outlier.
"The proposed changes would not 'force' any physician to work anywhere or take away their right to close their practice — which is clear in the College's proposed policies," he said.